Plotting the Future of Cytotechnology
An Environmental Analysis of the Driving Forces of Cytology
In 2005 the American Society of Cytopathology (ASC) formed the Study Group on the Future of Cytotechnology to explore the possibility of developing a new cytotechnology profession perhaps modeled after the physician assistant or nurse practitioner. This study group was formed based on what ASC considered “strong” evidence suggesting demand for cytotechnologists’ traditional services was declining while new technologies and treatments were creating new treatment services and patient needs that cytotechnologists could meet but not within their current training and scope of practice.
In its June 2005 report the study group, authored by Jean Taylor but submitted on behalf of the entire committee, found, “The rapid decline in the total volume of Pap smears that is just beginning to be reported across the nation could already be altering the favorable employment rates [cytotechnologists] have enjoyed for the last decade.”1 Supporting this statement, the Study Group observed that the number of schools offering cytotechnology programs peaked in 1995 at 67 and declined steadily over the next nine years during which 19 schools closed their cytotechnology programs. Over the same period, the number of enrolled students fell from 380 in 1995 to 292 in 2004, a decline of 25 percent. Another four schools discontinued their cytotechnology training in 2006. Among these schools included the prestigious Johns Hopkins University Medical School whose program closed due to lack of applications. This brings the total number of program closures to one in every three cytotechnology programs since the 1995 peak.
The Study Group observed with some alarm (based on the liberal use of exclamation points in this section of the report) that despite a decline in the number of newly minted cytotechnologists, the profession’s vacancy rate, based on a survey conducted by the American Society for Clinical Pathology (ASCP), fell steadily from 2002 through 2004, implying a decline in demand for cytotechnologists' (CT) services. The Study Group concluded that other trends including “the introduction of computer assisted screening technologies, the [recent] American Collage of Obstetricians and Gynecologists (ACOG) recommendations for longer intervals between screenings combined with HPV testing, and the development of HPV vaccines, and new, more precise molecular markers threaten to further reduce Pap smear volumes,” which ASC estimates accounts, on average, for 80 percent of the work in cytotechnology labs currently.2
ASC engaged The Forbes Group, a strategic counseling firm with extensive experience in working with healthcare organizations, to assess if market forces would support a new cytology profession between cytotechnology and cytopathology, what those forces were, how they would influence the scope of and payment for a “cytotechnology practitioner,” and how the relationships among the other cytology professions (cytopathologists and cytotechnologists) would change. The Forbes Group approach, called “Customers’ Customer Analysis”© did not look at cytotechnology in isolation. Instead it examined potential changes in cytotechnology within the context of changing demands being placed on its client, cytopathology, and cytopathology’s ability continue to serve as consultant to clinicians and their patients.
Based on an analysis of changing market models, payment mechanisms, patient demographics, and technologies The Forbes Group found that the relationships between the clinician and the pathologist and the pathologist and the technologists were undergoing profound reform and redefinition. As a result, perhaps several new professions were emerging to support the practice of cytopathology and clinical medicine in the future. What was clear that is not emerging is a hybrid technologist/pathologist profession, such as that recently was created through negotiations between the Royal College of Pathology and the Institute for Biomedical Sciences in the U.K.
Driven by the growing shortage of physicians, the diffusion of healthcare delivery out of centralized institutional environments, such as hospitals, and into independent practices has transformed the delivery of healthcare from closed, exclusive supply-chains to open, flexible provider networks that are geographically and professionally distancing the pathologist from the technologist.
New transformational technologies such as digital pathology, telemedicine, and nanotechnology are redefining the relationships among various medical specialties and subspecialties, even to the point of questioning whether anatomic and clinical pathology would remain distinct fields in the future. These new technologies also hold the possibility of transforming pathology from being strictly a consultative diagnostic function to a prognostic treatment role.
In each potential future, The Forbes Group asked how such changes in the practice of pathology would influence the support services the profession would demand. It concluded that anticipated changes in cytopathology would place numerous new demands on support functions that cannot be met by today’s cytotechnologists. In fact, ASC instead may have been looking at the features of several different emerging professions and trying to envision them within a single professional.
To support the growing demand placed on cytopathology, there will be new professional requirements in sample harvesting, quality analysis, and management that go well beyond the abilities of today’s cytotechnologists. The introduction of digital pathology brings with it technical skills in digital imaging and data management that today do not exist outside the radiology department. And ASC needs to identify what kinds of technical and professional support will be demanded by pathologists whose practice goes from lab table to bedside.